1 - 7 August 2014 #718

The Amarnath Yatra

Dhanvantari by Buddha Basnyat, MD

Almost all high altitude pilgrimages are characterised by very rapid ascents by large congregations leading to high rates of acute mountain sickness (AMS). In addition there may be tremendous overcrowding on the trail that is not seen in the usual non-pilgrim trekking trails in the Nepal Himalaya.

The Amarnath Yatra in Kashmir is among the more dangerous high altitude pilgrimages in the Indian Himalaya. Situated at about 4,000 m, this Shiva cave annually attracts a phenomenal 600,000 pilgrims. This year the Yatra started on 28 June and culminates next week on the full moon night of 10 August. Janai Purnima is also the day when our Gosainkunda Yatra in the Langtang region at 4,300 m ends with a holy dip in the surrounding lake. Both Yatras are in honour of Shiva. At Amarnath on the last day, about a hundred sadhus take a sacred mace to the Shiva shrine.

In 2011 and 2012 the Amarnath Yatra witnessed the death of over 100 pilgrims each year due to altitude sickness, hypothermia, and exacerbations of pre-existing illnesses. In 1996, about 250 pilgrims died, and the dangers are compounded by threats from militants in Kashmir. Last year, there were a lot fewer fatalities.

From Srinagar in Kashmir, pilgrims go to Pahalgam by road transport and then start their 5 to 6 days trek to the cave where the frozen Shiva Lingam is enshrined. There is another shorter one- day route from Baltal, but this is potentially more dangerous. The Indian government is trying to spread awareness about AMS and other dangers, and the Health Ministry is setting up a committee to effectively train the health care professionals along the trail. Obviously, AMS is an important cause of death and those looking after the pilgrims have to be well versed in this field.

But in addition, many pilgrims are poorly clad for this trek and suffer from the potentially fatal effects of hypothermia (cold temperature). Incredibly many of these partially-hypothermic pilgrims also take holy dips in icy rivers in the region. Ensuring that pilgrims have adequate warm clothing is very important, but many Sadhus may be reluctant to wear warmer clothes.

Unlike trekkers and mountaineers, pilgrims have more pre- existing illnesses (such as uncontrolled diabetes) which may make matters worse when they ascend to high altitude, especially as many also may fast along the way. Some of the important risk factors for AMS in pilgrims are gender and age, hence AMS risk factors derived from many other high altitude studies may not be generalisable for pilgrims.

Female pilgrims may be more at risk for AMS because they may take fasting more seriously than males and thus become very dehydrated. Among non-pilgrims, high altitude epidemiological studies show younger people are less susceptible to AMS. One important explanation may be that older pilgrims are generally less fit and have to exert themselves significantly more than someone who may be fitter. Excessive exertion may lead to AMS.

Studies of Amarnath Yatra pilgrims show that coronary artery disease, complications of diabetes and peptic ulcer disease are some of the common, important reasons for admission to hospitals during the trip.

If you are planning an Amarnath Yatra this season, it may be wise to learn more about the prevention of altitude sickness and hypothermia. In addition, any pre-existing illnesses (diabetes, coronary artery disease) should be well controlled and it helps to be reasonably physically fit before the trip. May you be rewarded with the magnificent scenery and a spiritual high.

Read also:

Altitude illness awareness

Pilgrimage Medicine

Conquering heights